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. 2023 Oct 30;59(11):1924.
doi: 10.3390/medicina59111924.

Cardiac Magnetic Resonance Left Ventricular Filling Pressure Is Associated with NT-proBNP in Patients with New Onset Heart Failure

Hosamadin Assadi  1   2 , Gareth Matthews  1   2 , Bradley Chambers  3 , Ciaran Grafton-Clarke  1   2 , Mubien Shabi  3 , Sven Plein  3 , Peter P Swoboda  3 , Pankaj Garg  1   2
Affiliations

Cardiac Magnetic Resonance Left Ventricular Filling Pressure Is Associated with NT-proBNP in Patients with New Onset Heart Failure

Hosamadin Assadi et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Cardiovascular magnetic resonance (CMR) is emerging as an important imaging tool for sub-phenotyping and estimating left ventricular (LV) filling pressure (LVFP). The N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) is released from cardiac myocytes in response to mechanical load and wall stress. This study sought to investigate if CMR-derived LVFP is associated with the serum levels of NT-proBNP and, in addition, if it provides any incremental prognostic value in heart failure (HF). Materials and Methods: This study recruited 380 patients diagnosed with HF who underwent same-day CMR and clinical assessment between February 2018 and January 2020. CMR-derived LVFP was calculated, as previously, from long- and short-axis cines. During CMR assessment, serum NT-proBNP was measured. The pathological cut-offs were defined as follows: NT-proBNP ≥ 125 pg/mL and CMR LVFP > 15 mmHg. The incidence of HF hospitalisation was treated as a clinical outcome. Results: In total, 305 patients had NT-proBNP ≥ 125 pg/mL. Patients with raised NT-proBNP were older (54 ± 14 vs. 64 ± 11 years, p < 0.0001). Patients with raised NT-proBNP had higher LV volumes and mass. In addition, CMR LVFP was higher in patients with raised NT-proBNP (13.2 ± 2.6 vs. 15.4 ± 3.2 mmHg, p < 0.0001). The serum levels of NT-proBNP were associated with CMR-derived LVFP (R = 0.42, p < 0.0001). In logistic regression analysis, this association between NT-proBNP and CMR LVFP was independent of all other CMR variables, including LV ejection fraction, LV mass, and left atrial volume (coefficient = 2.02, p = 0.002). CMR LVFP demonstrated an independent association with the incidence of HF hospitalisation above NT-proBNP (hazard ratio 2.7, 95% confidence interval 1.2 to 6, p = 0.01). Conclusions: A CMR-modelled LVFP is independently associated with serum NT-proBNP levels. Importantly, it provides an incremental prognostic value over and above serum NT-proBNP levels.

Keywords: CMR; MRI; diastole; heart failure; left ventricular end-diastolic pressure.

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Conflict of interest statement

P.G. is a clinical advisor for Pie Medical Imaging and Medis Medical Imaging. All other authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Correlation of NT-proBNP to CMR-derived LVFP. (a) Scatter plot with heat map demonstrating the association. (b) Difference in CMR-derived LVFP in raised versus normal NT-proBNP levels (p < 0.001).
Figure 2
Figure 2
Association of NT-proBNP to all CMR functional and volumetric variables. (a) Radial bar chart demonstrating independent association of CMR LVFP to NT-proBNP in logistic regression. (b) Odd ratios for all CMR-derived indices associated with raised NT-proBNP.
Figure 3
Figure 3
Survival analysis. (a) Kaplan–Meier analysis demonstrates patients with raised CMR LVFP had a higher risk of hospitalisation. (b) This risk of hospitalisation remained even after factoring in NT-proBNP levels in Cox Proportional Hazard Analysis.
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